Lisa is a HIV social worker at Ward 86 in San Francisco General Hospital, the oldest outpatient HIV/AIDS clinic in the world. She manages the Women’s Clinic which specializes in transgender women’s health. Transgender women have the highest HIV prevalence group in the city require some of the most complex medical treatment.
“Do you want to see my vagina?”Usually, I am only asked those kind of questions in the dark. Today I am under the fluorescent hospital lights in my office during a counseling session with a transgender woman, Vanessa. She is giddy with excitement after arriving home from Thailand where she had her sexual reassignment surgery. “I am sure it is lovely, but no thank you,” I reply.
Vanessa is a 6’3 woman living with bipolar disorder who commands attention. She came this morning to our Women’s Clinic, a supportive community where HIV-positive ladies can let their hair down while taking care of their health. She announces to all in the waiting room that she just had her long-awaited surgery. The other ladies applaud. Fed up with being denied by insurance to cover her surgery costs, she had traveled to Thailand where the surgery procedures are less regulated and less expensive.
I ask her to tell me about what is it like for her to have a vagina. Sometimes I can’t believe the words that come out of my mouth at work! But, the therapy begins here. Vanessa discusses her new self confidence in her transformed body. At age 45, she struggled her whole life to be a complete woman. Finally her body matches her mind. She talks about how she has hated her penis since early childhood. She feels relieved to have that weight off her body. She describes the joy of no longer feeling embarrassed in that moment when she disrobes in front of her male partners. She asks me to help her with the paperwork to change the gender on her passport, state ID, and insurance card to legally reflect her new identity.
Our gynecologist works with her on how to dilate her vagina properly for post-treatment care. My counseling over the following weeks with Vanessa centers around delaying sexual intercourse for the first two months during her post-treatment care so that her body can heal properly. She bursts at the exciting thought of “losing my virginity.” She has had so many offers in her sex work from men that she has a hard time putting her health first. Her new vagina raises her current market value. She brags telling me she’ll likely earn more money than me this year.
We are a funny working team. Dressed in all men’s clothing, I nod in agreement as I listen to her discuss bending gender lines to feel comfortable. My Catholic upbringing makes me somewhat hesitant when we talk about her sexual history. But Vanessa usually blurts it all out loud before I even ask. She teaches me to keep it real and loosen my language. We both feel at ease with one another. After all, Women’s Clinic is about just being yourself.
To protect the privacy of patients’s confidentiality, Vanessa’s name and some descriptors were changed to protect her identity. The photo is of a young transgender women from Life As a Transgender.